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影响疑似吸入性肺炎犬生存的潜在风险、预后指标以及诊断和治疗方式:125例病例(2005 - 2008年)

Potential risks, prognostic indicators, and diagnostic and treatment modalities affecting survival in dogs with presumptive aspiration pneumonia: 125 cases (2005-2008).

作者信息

Tart Kelly M, Babski Danielle M, Lee Justine A

机构信息

Section of Emergency and Critical Care, Department of Veterinary Clinical Sciences, C339 Veterinary Medical Center, College of Veterinary Medicine, University of Minnesota, St Paul, MN 55108-6192, USA.

出版信息

J Vet Emerg Crit Care (San Antonio). 2010 Jun;20(3):319-29. doi: 10.1111/j.1476-4431.2010.00542.x.

Abstract

OBJECTIVE

To evaluate a clinical population of dogs diagnosed with presumptive aspiration pneumonia (AP) and determine diagnostic and treatment modalities contributing to survival.

DESIGN

Retrospective study.

SETTING

A university veterinary teaching hospital in an urban setting.

ANIMALS

One hundred and twenty-five dogs with presumed AP treated from 2005 to 2008.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Dogs with presumptive AP identified by a review of medical records had an overall survival of 81.6% (102/125). Male large-breed dogs (mean 24.9 kg; 82/125) were overrepresented and were more likely to develop AP in this study population. Recent anesthesia had been performed in 16% (20/125), and vomiting was reported in 64% (80/125). The most common radiographic findings were a predominantly alveolar pattern (187/272, [68.8%] total lung lobes) in the right middle lung lobe (80/115, [69.6%]). A mean of 2 lung lobes were involved radiographically, and the relationship between survival and the number of lung lobes affected was statistically significant (P=0.04). Neutrophilia with a left shift was common with no significant change on consecutive daily evaluations. The mean PaO(2) was 77.7 mm Hg (SD, 17.5 mm Hg) (range, 40.7-100 mm Hg) with a median alveolar-arterial gradient of 41.1 mm Hg (range, 8.1-81.8 mm Hg). In this study population, 37.6% (47/125) of dogs had microbial cultures performed and of these, 76.6% (36/47) were positive for growth; Escherichia coli (38.8%), Mycoplasma spp. (21.3%), Pasturella spp. (19.1%), and Staphylococcus spp. (17%) were the most common isolates in either single or multiagent infections. No treatment modality was statistically associated with increased survival. Colloid therapy was a negative prognostic indicator.

CONCLUSIONS

In this study the overall prognosis for AP was good. Patients with only 1 affected lung lobe appeared more likely to survive. Supportive treatment modalities are warranted for the hospitalized patient, although no individual treatment method was found to be clearly superior to others.

摘要

目的

评估被诊断为疑似吸入性肺炎(AP)的犬临床群体,并确定有助于生存的诊断和治疗方式。

设计

回顾性研究。

地点

城市环境中的一所大学兽医教学医院。

动物

2005年至2008年期间接受治疗的125只疑似AP犬。

干预措施

无。

测量指标及主要结果

通过病历回顾确定的疑似AP犬的总体生存率为81.6%(102/125)。雄性大型犬(平均24.9千克;82/125)占比过高,且在本研究群体中更易发生AP。16%(20/125)的犬近期接受过麻醉,64%(80/125)的犬有呕吐报告。最常见的影像学表现为右中叶以肺泡型为主(共187/272个肺叶,[68.8%])(80/115个肺叶,[69.6%])。影像学检查平均累及2个肺叶,生存与受累肺叶数量之间的关系具有统计学意义(P = 0.04)。核左移的中性粒细胞增多常见,连续每日评估无显著变化。平均动脉血氧分压(PaO₂)为77.7毫米汞柱(标准差,17.5毫米汞柱)(范围,40.7 - 100毫米汞柱),肺泡 - 动脉血氧分压差中位数为41.1毫米汞柱(范围,8.1 - 八十一点八毫米汞柱)。在本研究群体中,37.6%(47/125)的犬进行了微生物培养,其中76.6%(36/47)培养出阳性生长;大肠杆菌(38.8%)、支原体属(21.3%)、巴斯德菌属(19.1%)和葡萄球菌属(17%)是单一或混合感染中最常见分离菌。没有治疗方式与生存率提高在统计学上相关。胶体治疗是一个不良预后指标。

结论

在本研究中,AP的总体预后良好。仅1个肺叶受累的患者似乎更易存活。尽管未发现单一治疗方法明显优于其他方法,但对于住院患者支持性治疗方式是必要的。

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